From the Guidelines
Hand-foot syndrome, also known as palmar-plantar erythrodysesthesia (PPE), is a post-chemotherapy phenomenon that can be managed with preventive measures such as behavioral aspects and skin care, including avoidance of mechanical and chemical stress, and treatment with topical high-potency steroids and oral dexamethasone, as recommended by the ESMO clinical practice guidelines 1. The management of PPE involves a step-wise approach based on the severity of the condition, as outlined in Table 4 of the ESMO guidelines 1.
- For Grade 0 prevention, behavioral aspects and skin care are recommended, including avoidance of irritation to the hands and feet, and use of urea 10% cream at least twice daily.
- For Grade 1 treatment, continuation of the drug at the current dose and monitoring for change in severity, along with topical high-potency steroid and cooling of hands and feet during infusions, are recommended.
- For Grade 2 treatment, continuation of the drug at the current dose and monitoring for change in severity, along with topical high-potency steroid, oral dexamethasone, and cooling of hands and feet during infusions, are recommended.
- For Grade 3 or intolerable Grade 2 treatment, interruption of treatment until severity decreases to Grade 0-1, and continuation of treatment of skin reaction with topical high-potency steroid and oral dexamethasone, are recommended. It is also important to note that pyridoxine has shown no benefit in preventing PPE in well-designed randomized studies, and is therefore not recommended 1. Additionally, celecoxib has been shown to prevent PPE induced by capecitabine in metastatic colorectal cancer patients, but its use should be tailored to each patient due to potential adverse effects and unclear interactions with tumor response 1. Overall, the management of PPE should prioritize measures to reduce the severity of the condition, improve quality of life, and minimize the impact on daily activities.
From the Research
Definition and Incidence of Hand-Foot Syndrome
- Hand-foot syndrome (HFS), also known as palmar-plantar erythrodysesthesia (PPE), is a common skin reaction to systemic therapy, particularly with chemotherapeutic agents such as capecitabine, pegylated liposomal doxorubicin, and fluoropyrimidines 2.
- The incidence of HFS is dependent on the chemotherapeutic drug used, the treatment schedule, and the median duration of treatment 2.
Prevention and Management of Hand-Foot Syndrome
- Several studies have investigated the efficacy and safety of prophylactic agents such as pyridoxine, celecoxib, urea cream, and cystine/theanine in managing HFS 3, 4, 5, 6.
- Celecoxib has been shown to significantly prevent the incidence of moderate to severe HFS (grade ≥2) 3, 4.
- Urea cream has been found to reduce the incidence of severe HFS and is a safe and viable topical prevention strategy 5.
- Pyridoxine may have some efficacy in preventing HFS, particularly at a dose of 400 mg daily, but further studies are needed to evaluate its efficacy and safety 6.
Treatment-Related Toxicity and Quality of Life
- HFS can cause significant discomfort and impairment of function, especially in elderly patients, and may seriously impact quality of life 2.
- Effective measures for prevention and treatment of HFS, such as systemic and topical treatments, dose reductions, and switching to other drugs, can help reduce negative impacts on quality of life 2.
- Awareness and early recognition of HFS are important to ensure timely treatment and avoidance of dose reductions or treatment discontinuation 2.